Nephrolithiasis associated with ceftriaxone therapy: a prospective study in 51 children

Abstract

Background: Background: Ceftriaxone, a third generation cephalosporin, is widely used for treating infection during childhood. The kidneys eliminate approximately 33-67% of this agent, and the remainder is eliminated via the biliary system. Ceftriaxone may bind with calcium ions and form insoluble precipitate leading to biliary pseudolithiasis. The aim of this study was to assess whether ceftriaxone associated nephrolithiasis develops by the same mechanism, and whether this condition is dose related. Methods: The study involved 51 children with various infections. Of these, 24 were hospitalized with severe infection and received 100 mg/kg/day ceftriaxone divided into two equal intravenous doses. The other 27 patients received a single daily intramuscular injection of 50 mg/kg/day. Serum and urine parameters were evaluated before and after treatment, and abdominal ultrasonographic examinations were also carried out before and after treatment. Results: Serum urea, creatinine, and calcium levels were normal in all patients before and after treatment. Post-treatment ultrasound identified nephrolithiasis in four (7.8%) of the 51 subjects. The stones were all of small size (2 mm). Comparison of the groups with and without nephrolithiasis revealed no significant differences with respect to age, sex distribution, duration of treatment, or dose/route of administration of ceftriaxone. The renal stones disappeared spontaneously in three of the four cases, but were still present in one patient 7 months after ceftriaxone treatment. Conclusions: Conclusions: The study showed that children taking a 7 day course of normal or high dose ceftriaxone may develop small sized asymptomatic renal stones. The overall incidence of nephrolithiasis in this study was 7.8%.

Ceftriaxone and Acute Renal Failure in Children

“…Approximately 33% to 67% of ceftriaxone is excreted unmetabolized in the urine, whereas the remainder is excreted through biliary elimination. 1 Clinical studies have demonstrated that ceftriaxone can cause biliary pseudolithiasis, 2,3 nephrolithiasis, [4][5][6][7] and bladder sludge, 8 especially in children.…”

“…4,6,7 After cessation of ceftriaxone therapy, the stones vanish by themselves. With this view, we initiated pharmacotherapy for all children upon diagnosis, and 9 children responded well.…”

“…[4][5][6][7] However, ceftriaxoneassociated PARF [9][10][11] has been rarely reported. In this study we identified 31 children who had PARF who had a definite history of ceftriaxone treatment demonstrating the causal role of ceftriaxone in PARF.…”

Protective effect of Matricaria Chamomilla extract on hepatic-renal toxicity of ceftriaxone in rats

“…Ceftizoxime undergoes biotransformation in liver to inactive form metabolite resulting in decrease concentration in blood (Sar et al 2006, Bakul et al 2009). The drug is primarily eliminated via the kidneys (33-67%) with remainder eliminated via the biliary system and bind with calcium ions producing biliary pseudolithiasis (Avci et al 2016). The liver eliminates a considerable proportion of ceftriaxone in the form of a soluble salt (Avci et al 2016), ceftriaxone is an anion when its concentration become high these anions bind with calcium ions to form insoluble complexes that precipitate out the biliary system (Shiffman et al 1990, Park et al 1991 Combination of herbs with chemotherapy may be used to decrease adverse effects, elevate the immune function and improve the quality of life in the patients (Ragaa et al 2011).…”

“…The drug is primarily eliminated via the kidneys (33-67%) with remainder eliminated via the biliary system and bind with calcium ions producing biliary pseudolithiasis (Avci et al 2016). The liver eliminates a considerable proportion of ceftriaxone in the form of a soluble salt (Avci et al 2016), ceftriaxone is an anion when its concentration become high these anions bind with calcium ions to form insoluble complexes that precipitate out the biliary system (Shiffman et al 1990, Park et al 1991 Combination of herbs with chemotherapy may be used to decrease adverse effects, elevate the immune function and improve the quality of life in the patients (Ragaa et al 2011). Hypothesis of this study is Matricaria Chamomilla extract has protective effect on hepato-renal toxicity which induced during ceftriaxone injection in male albino rats by monitoring the biochemical changes in serum and histopathological findings in liver and kidney.…”